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<br /> MEMO _MW
<br /> UNIFIED FiROGRAM CONSOLIDATED FORM
<br /> UNDF,RGROUND STORAGE TANK
<br /> OPE RATING PERMIT APPLICATION-TANK:IN P'ORMATTON ono farm per UST)
<br /> TYPE OF ACTION (Check one item only, Fnr an UST permancnt closure or removal,complete only this section and Sections 1,11,111,IV,and IX below) 410
<br /> ❑ 1.1VEW PERMIT L] 3.RP.NEIWA1,PERMIT ® 5.CHANGE OF INFORMATIONVP f
<br /> I
<br /> El 6,TEMPORARY UST CLOSURE 0 7,UST PERMANENT CLOSURP.ON STTF R,UST REMOVAL
<br /> DATE UST PERMANENTLY CLOSED' 430 DATA P7U.STING UST DISCOVERED: � "�
<br /> I. FACILTTY INIi'ORMLATION
<br /> I
<br /> FACILITY TD ft(4gency Use Only) - s' c
<br /> BUSINESS NAME(Same nc FACILITY NAME;0r DBA-Doing Busiocss As) J 3
<br /> Thomton 76
<br /> BUSINFSS SITE ADDRESS 10l CITY tae
<br /> 8606 Thorntalr Road Stocictorl
<br /> + _ t TANKDIuSCR TION,
<br /> TANK 11)4 4,12 TANK MANUFACTURER 433 TANK CONFIGURATION'THIS TANK 14 434
<br /> 3-Premium Xerxes ®1.A STAND-ALONE TANK
<br /> -_' .. `�, _ ❑2,ONE W A COMPARTMIINTED UNIT.
<br /> Com IatO aIIG c for enah oOm IltlroOAl is rha imh.
<br /> DATE UST SYSTEM INSTALLED 40S TANK CAPACITY IN(IAF.i.OTJS 416 1•tjJMHSE2 OF COMPARTMENTS IN n-iE UNIT 417
<br /> 1988 10,000
<br /> .', .. ''. .:�� �.�,, l --: � , `' � . `;`�1��`�A1�CU�E'A,ND_'Ct►NTENTS � '.' c _ •.�
<br /> TANK USE ® in.MOTOR VEITICLE rUELINO ❑ Ib.MARINA PUF1,rNC ❑ Ic.AVIATION FURLING A19
<br /> f] 3,CHRM►CAL PRODUCT STORAGE Q 4.HAZARDOUS WASTE(Tnatuded Ua41i nth d 5.LMERGv.NCY GEwSRATOR FUEL iiTSC P52R 1,5(e)J
<br /> ❑ 6,OTHER OFNERATOR FUEL Q 95.UNKNOWN ❑ 99.OTHER_(:IpC6 : 439n
<br /> CONTENTS IST'ROLEUM: N 1o,REGULAR UNLEADED ❑ I c,MiDGRADE UNLEADED ® Ib.PRFMi N UNT,FADF.D 44n
<br /> ❑ 3_DiESEL ❑ 5,,TET FUEL ❑ 6.AVIATION GAS
<br /> ❑ 8_PBTROLaW TILTUD FUEL ❑ 9,OTHER P17TPOLFUM (Specify: -1404
<br /> NON-Pi3TROLEUM:Q 7.USED OIL ❑ In,ETHANOL
<br /> Q 11.OTHER NON-PRTROLRUM(Specify,): 4a0b
<br /> `[V K'CONSTR imhON a..
<br /> TYPE.DT TANK ❑ 1_SINGLF WA Li. N 2,D01MLE'VALE 95.UNKNOWN 443
<br /> PRIMARY CONTARST(ENT ❑ r,TMEL k3 a,17TRERGLASS 066.INTERNAL T3T,A1131,A13DFIt 444
<br /> ❑ 7,STFIRL+DiTERNAL LINiNO ❑ 95,UNKNOWN ❑ 99.OTHER (5pcci
<br /> SECONDARY CONTAINMEN-1' i.STFI?L }�3.FIRERG1.ASS ❑ 6.EXTL•RIOR 141EMARANI?I.rNP,R ❑ 7.JACKF'iTT) 445
<br /> ❑ 9D.NONE ❑ 95,UNKNOWN 13 99.OTHER_(S ecir 145n
<br /> OVERFn.r.PREvEN-TION ai,AUDWLZ&VISUAL AJ,ARMS 2.ISALL FLOAT M 3_rnLL-I-UAE SIiIPI.OFP VAI.VE 432,
<br /> ❑ 4_TANK MEETS REQUf..10MENTS fOlt.EXEMPTION FROM OVERFILL PREVENTION PQUiPMENT
<br /> :71 +.;V:';PRODUCT-/sWAiSTL rfPEYG CONS.TRUCTIOX.
<br /> PIPING CONSTRUCTION ❑1.SINGJ,P-WAI,I.FD 2.DOUBLFrWALT..F TJ ❑99,OTiIER 46n
<br /> SYSTEM TY"- @ 1,PRESSURE LJ2.GRAVITY ❑ 3.CONVENTiONAL SUCTION 4.3AI7E SUCTION[2t CCR§2f,36(n)(3)J 4SA
<br /> PRIMARY CONTARENT ❑ 1.SMI, Eel4,FITIMO.ASS S.F1.E.KiBLS 10.RIGR7 P4ASTIC 464
<br /> iN
<br /> ❑ 90.NOTfis ❑ 95.UNKNOWN ❑ 99.OTHER(Spc6ly): 464n
<br /> SECONDARY CONTAINMENT ❑ I,STEEL --W4,FOERGi,ASS ❑ 8.FLEXIBLE ❑ ro.RiOiD l'1,ASTiC 4641,
<br /> ❑ 9o,NDNr,, Q 95.UNKNOWN ❑ 99,O7FIFR S eolf)• 4640
<br /> r miNG/T TRBINE CONTATNMENT SUMP TYPE N 1,SINGLE WALL 0 2.DOUBLE WALL ❑ 90.NONE_ 4641
<br /> VX';VLNTjVAPOR!ItECOVS)LtR%F1d=%TUl?VP�I1N000NST'RUCTION
<br /> VENT PRIMARY CONTAINMENT 1,ST3ET, N 4.F158PLGLAS3 Lj 10,RIGID PLASTIC ❑ 90.NONE 99,OTHER CSPeaW Y) 4640
<br /> afi4rl
<br /> VENT SFQQNDARY CONTAINMENT 1,STEEL 4.NIHLRGLASS I0.RIGID PLASTIC 0 90.NONE LJ 99,OTITFR(Spa6r-y) 464r
<br /> 464f1
<br /> VR PRIMARY CONTAINMENT ].STEEL 4.FIBERGLASS Ij I D•RTGTD PLAS'nC ❑ 90.NONE99.OTFUN(Rr-ity) 464n
<br /> _464al
<br /> VR SECONDARY CONTAINMENT 1,STEEL IN 4.rMERGLASS 10.RIGID PLASTIC 0 90.NOMI 99.OTHER(SPe6iry) 464h
<br /> 464hr
<br /> VENT FrFrNG TRANSITION SUMP TYPE N I,STNOiri WALL 2.DOUBLA WALL. 9o,NONE 4611.
<br /> RISF,R rRrMARY CONTAWMpNT 1.STEEL 4.PIDERGLASS 10,RIGID PLASTIC 90.NONE 99,OTKRR(Spaoify) 4641
<br /> 4fi4'I
<br /> RISER SECONDARY CONTAINMENT ❑ 1.STEEL 0 4,FIBURGLASS ❑ 10,TLTGM PLASTIC ❑ 90,NONE 99,OTEIFR(Spceity) 461k
<br /> 4F4k1
<br /> PILL COMPONENTS iNSTALLED 1.SPU BUCKET 0 3,STRIKER PJ.ATF✓I30TTOM PROTECTOR 0 4.CON'i'AINNIENT SUMP ai t n.o
<br /> VII.UNDEjR1DISPENSER CONTATNw,NT:(ZrDC)
<br /> CONSTRUCTION TYPE )9 1.SINGLE WALL Q 2.DOUBL9 WALT, ❑ 3.NO DISPENSERS Q 90,NONE 469n
<br /> CONSTRUCTION VATERIAL 0-1,STEEL 0 4.FMPRGI,ASS ❑ 10,RTOM PLASTIC ❑ 99.OTHER(Spocil') a<96•c
<br /> VM. CORROSION FROTF,CTI;ON
<br /> STpL•I.COMPONENT PROTECTION ❑ 2,SACTLIFTCIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6,TSOI„ATION aas.
<br /> ]I , .AFFLI'CANT STGNAT.URt
<br /> CERTIh[CATION: 1 certify that this UST system is eompntlble with thp hnzarllrnly snhstnnce stnrclf Find that the Infnrmntion provided herein Is true,accurate,
<br /> nod In h1[i rnm llnncc with lcgnl rc ulrenlcnls, _-
<br /> APPLICANT SIGNATURE, DATE 170,
<br /> 6/29/2009
<br /> APPLICANT NAME(print) 471' APPI,iCANT TJTI-F 47z,
<br /> Amar'IL,Rai Owner
<br /> UI'CT UST-13-213 ttev.(1212007)
<br />
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